Background: Endoscopic thyroidectomy is popular among patients with cosmetic requirements. However, when lateral neck dissection (LND) is required, endoscopic surgery may be challenging. Therefore, we introduced needle-assisted endoscopic technique to achieve endoscopic LND procedure and evaluated its safety and feasibility in the present study. Methods: Medical records of 37 patients who underwent needle-assisted endoscopic thyroidectomy with LND were retrospectively reviewed. Results: All of 37 patients had excellent cosmetic outcomes. The mean operative time was 338.2 ± 58.74 minutes. Mean number of lymph nodes retrieved in the lateral was 33.5 ± 11.69 and 15.9 ± 7.51 in the central neck. The rates of transient and permanent hypocalcemia were 32.4% and 2.7% and the rates of transient and permanent recurrent laryngeal nerve palsy were 8.1% and 0%, respectively. Conclusions: Needle-assisted endoscopic thyroidectomy with lateral neck dissection shows potential feasibility but further study is needed to better characterize its safety and applicability. K E Y W O R D Spapillary thyroid carcinoma, endoscopic thyroidectomy, lateral neck dissection, needle assisted, anterior chest approach

Background:More surgeons had noticed the importance of carbon nanoparticles (CNs) in protection of parathyroid grand in the surgery of thyroidectomy and central lymph lode dissection, but paid less attention to the injection time. The purpose of this study was to investigate whether preoperative injection of CNs can improve the dissection of lymph nodes (LNs) and protect parathyroid grand (PG) for the patients with papillary thyroid carcinoma (TC).Methods:A total of 102 consecutive patients were enrolled into this study from August 2016 to June 2017. All the patients were divided randomly into preoperative group and intraoperative group by the injecting time of the CNs. We compared the patients who had CNs injected into thyroid gland 1 month before surgery with a control group of patients who had CNs injected during the operation. The primary endpoints were operative time, numbers of total LN and metastatic LN, ratio of PG auto-transplantation, parathyroid hormone (PTH) level, and postoperative complications.Results:We identify 206 PGs and 162 PGs in the preoperative and intraoperative group, respectively, (P = .000) and there was low ratio of auto-transplantation in the preoperative group compared with the intraoperative group (39.3% vs 50.62%, P = .003). We also found that the PTH level in the preoperative group was higher than that of preoperative group (2.60 ± 1.00 vs 2.19 ± 0.72, P = .021), and the operation time in the preoperative group was less than the intraoperative group (60.17 ± 6.28 vs 80.94 ± 7.12, P = .000). Meanwhile pathological results revealed 3 PGs of accidental removal occurred in the preoperative group, whereas 9 PGs of accidental removal occurred in the intraoperative group (P = .039). Also there was no difference in the numbers of total and metastatic LN in the 2 groups (P > .05).Conclusion:Preoperative injection of CNs was safe, and can help protect PG and reduce the difficulty of operation.

The efficacy of a danshen (Salvia miltiorrhiza) dripping pill (DDP) for secondary stroke prevention was evaluated in patients with ischemic cerebrovascular disease. The preparation also contained Panax notoginseng (sanqi) and Dryobalanops camphor. Patients who had suffered from ischemic stroke or a transient ischemic attack (TIA) within the previous 20 days were managed according to established guidelines, and were divided into groups to receive either DDP or non-DDP treatment according to their time of enrolment. Mortality, cerebrovascular events and any suspected adverse reactions during the 1-year follow-up were recorded and analysed. Hematological and hemorheological parameters were measured at the start of the study (baseline) and the end of the follow-up period. A total of 106 patients with ischemic stroke/TIA were enrolled, of which 52 were allocated to take DDP and 54 were in the control group. Recurrent stroke/TIA was observed in five patients (9.6%) with DDP and in 13 patients (24.1%) without DDP during the follow-up. Recurrence in the patient group taking DDP was lower than that in the control group (p<0.05). No significant differences in intracranial hemorrhage and mortality were detected between groups (p>0.05). Blood C reactive protein decreased significantly in patients with DDP compared with patients without DDP. These results indicate that DDP treatment may reduce the risk for stroke/TIA recurrence, and this reduction of risk may be associated with its antiinflammatory effects.

Objective: We aimed to establish an artificial intelligence (AI) model to identify parathyroid glands during endoscopic approaches and compare it with senior and junior surgeons' visual estimation.Methods: A total of 1,700 images of parathyroid glands from 166 endoscopic thyroidectomy videos were labeled. Data from 20 additional full-length videos were used as an independent external cohort. The YOLO V3, Faster R-CNN, and Cascade algorithms were used for deep learning, and the optimal algorithm was selected for independent external cohort analysis. Finally, the identification rate, initial recognition time, and tracking periods of PTAIR (Artificial Intelligence model for Parathyroid gland Recognition), junior surgeons, and senior surgeons were compared.Results: The Faster R-CNN algorithm showed the best balance after optimizing the hyperparameters of each algorithm and was updated as PTAIR. The precision, recall rate, and F1 score of the PTAIR were 88.7%, 92.3%, and 90.5%, respectively. In the independent external cohort, the parathyroid identification rates of PTAIR, senior surgeons, and junior surgeons were 96.9%, 87.5%, and 71.9%, respectively. In addition, PTAIR recognized parathyroid glands 3.83 s ahead of the senior surgeons (p = 0.008), with a tracking period 62.82 s longer than the senior surgeons (p = 0.006).Conclusions: PTAIR can achieve earlier identification and full-time tracing under a particular training strategy. The identification rate of PTAIR is higher than that of junior surgeons and similar to that of senior surgeons. Such systems may have utility in improving surgical outcomes and also in accelerating the education of junior surgeons.